Esophageal Cancer: Surgery

Surgery can sometimes be used to treat esophageal cancer. Different kinds of surgery may be done. The type you have depends on where the cancer is, how much it’s spread, and other factors. 

When might surgery be used for esophageal cancer?

Surgery is often used to treat early stage esophageal cancer, especially cancer in the lower part of the esophagus. It’s often used along with other treatments. These can include radiation therapy and chemotherapy. 

Types of surgery for esophageal cancer

Esophagectomy/esophagogastrectomy

The main surgery used to treat this type of cancer is esophagectomy. In this procedure, the healthcare provider removes part or all of your esophagus. He or she may also take out nearby lymph nodes to check them for cancer. For cancers in the lower part of the esophagus, some of the stomach might also be removed. This is called an esophagogastrectomy. The pieces of the esophagus or stomach that are left are then reconnected. If there isn’t enough esophagus left to reconnect the ends, the surgeon might use a section of intestine to bridge the gap.

This type of surgery can be done in 2 ways:

  • The surgeon makes cuts in your neck, chest, or abdomen (belly) to remove the esophagus. Where the cuts are made depends on where the cancer is in the esophagus.

  • For smaller tumors, the surgeon may be able to operate through smaller cuts. A flexible tube with a tiny camera on the end of it is put in one cut to see inside your body. Long, thin surgical tools are put in the other cuts to do the surgery. Because the cuts are smaller, people may recover more quickly. 

Both approaches are complex. You may need a long hospital stay. It’s important that the surgeon has a lot of experience.

Palliative surgery

For cancers that are bigger or have spread, other, less complex surgery may be done. This can help with problems such as trouble eating. For instance, surgery may be done to put a feeding tube through your skin and into your stomach or small intestine. Or the healthcare provider may put an expandable metal tube (stent) into your esophagus. This helps keep the esophagus open so food can pass through.

Possible risks, complications, and side effects of surgery

All surgery has risks. Some of these risks include:

  • Reactions to anesthesia

  • Heavy bleeding

  • Infection

  • Blood clots in your legs or lungs

  • Damage to nearby organs

Risks from esophageal surgery

Along with the risks above, esophageal surgery can sometimes cause other problems. These can include:

  • Pneumonia. Some people have lung problems after surgery. This can lead to pneumonia.

  • Anastomotic leak. After the surgeon removes a part of the esophagus, or the esophagus and stomach, he or she attaches the 2 ends together. A leak can occur at this connection. You might need surgery to fix this.

  • Esophageal stricture. The part of the esophagus that's attached to the stomach might become narrower. This can cause problems swallowing. Other procedures might be needed to stretch the tight area.

  • Heartburn. After surgery, contents from your stomach might back up into your esophagus more easily. This could lead to heartburn. Antacids or other medicines can help.

Getting ready for your surgery

Before you go for surgery, you’ll meet with your surgeon to talk about it. At this time, ask any questions and share concerns you may have. This is also a good time to review the side effects of the surgery and to talk about its risks. You might ask if the surgery will leave scars and what those scars will look like. You might also want to ask when you can expect to return to your normal activities. After you have discussed all the details with the surgeon, you’ll sign a consent form that says that he or she can do the surgery.

A few days before your surgery, your healthcare provider might give you laxatives and enemas to help clean out your colon. He or she will tell you when and how to use these. You may also be told to follow a special diet.

On the day of your surgery, you should arrive at the hospital admission area a couple of hours before the time your surgery is set to start. There, you'll complete the needed paperwork and go to a preoperative area. In this area, you’ll undress and put on a hospital gown. During this time, your healthcare team will ask you about your health history. They’ll also ask about medicine allergies and talk about the procedure. Try not to get frustrated by the repetition. These questions are repeated to help prevent mistakes.

While you’re in the preoperative area, an anesthesiologist or a nurse anesthetist will do an assessment. He or she will also explain the anesthesia you’ll have during your surgery. The purpose of the anesthesia is to put you to sleep so that you won't feel any pain. Answer all the questions thoroughly and honestly. This will help prevent complications. Also ask any questions you have about the anesthesia medicine that will be used. You'll sign a form that states that you understand the risks involved.

Your surgeon will also see you in the preoperative area. You can ask any last-minute questions you have. This may help put your mind at ease.

What to expect during surgery

When it’s time for your surgery, you’ll be taken into the operating room. Many healthcare providers will be there. These include the anesthesiologist, surgeon, and nurses. Everyone will be wearing a surgical gown and a face mask. Once in the room, you'll be moved onto the operating table. There, your anesthesiologist or nurse will put an IV (intravenous) line into your arm. This requires just a small skin prick. Someone will put special stockings on your legs to help prevent blood clots. The healthcare team will put ECG wires on your chest with small, sticky pads. This is done to monitor your heart. You’ll also have a blood pressure cuff wrapped around your arm. When all the preparation is complete, you’ll get the anesthesia through the IV and will fall asleep.

During surgery, the team may put a Foley catheter through your urethra and into your bladder. A Foley is a hollow tube used to drain urine into a bag. You’ll also have a breathing tube placed in your windpipe. A breathing machine (ventilator) will control your breathing. A nasogastric (NG) tube may be put in through your nose. This is a suction tube that goes through the esophagus and into your stomach to drain stomach contents. 

What's removed during surgery and where the incisions (cuts) are depend on the type of surgery you have. This is based on where the tumor is.

After your surgery is done, healthcare staff will move you to the recovery room. There, they'll watch you for another hour or two. When you wake up, don't be alarmed by the number of tubes and wires attached to you. These are normal monitors for after surgery. When you’re fully awake in the recovery room, your family will be able to see you for a short time. Once you’re awake and stable, you'll be moved to a regular hospital room.

What to expect after surgery

When you first wake up, you might have some pain. Your nurse will give you pain relievers as needed. These can help you feel more comfortable. The pain medicines will also help you get up and walk after your surgery. This is important for your recovery.

It will take time to get back to eating normally and having regular bowel movements. You'll still have the Foley catheter in your bladder to drain urine. It allows your healthcare providers to measure your urine output and keep track of your fluid status. It’s taken out before you go home.

How long you stay in the hospital will depend on the type of surgery you have. People who have a minimally invasive (laparoscopic) esophagectomy can often go home sooner. This is because they have smaller incisions that can normally heal faster.

You can slowly return to most normal activities once you leave the hospital. But don't lift anything heavy for several weeks. Always follow the instructions you get from your healthcare team.

After surgery, you may feel weak or tired for a while. The amount of time it takes to heal and recover is different for each person. You may not feel like yourself for several months.

Your healthcare providers will give you instructions about whether and when you can get your incisions wet. You likely won't be able to drive for a while. Be sure you understand all the instructions you get from your healthcare providers.

Talk to your healthcare team

If you have any questions about your surgery, talk to your healthcare team. They can help you know what to expect before, during, and after your surgery.

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